| NPI | 1245348705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ 6876) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 14729) |
| 1223P0300X Dentist, Periodontics (Licence: AR 2490) | |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2009-06-08 |